Sleep Apnea

There are many types of sleep disorders, but one of the most common – and most serious – is sleep apnea. Most of us have likely heard or read something about sleep apnea and usually associate it with a big, loud machine and an odd-looking mask that are used at night. But because it can create alarming health risks, there is much more we should know.

While there are a few different forms of the condition, the most common is obstructive sleep apnea or OSA. This sleep disorder is one in which breathing is interrupted constantly throughout the night when airways become blocked.

People of any age can have OSA, including infants and children, but it is most often seen in men over 40 and particularly among those who are overweight or obese. It is estimated that as many as 22 million Americans have sleep apnea with nearly 80 percent of those cases going undiagnosed.

What is sleep apnea?

Obstructive sleep apnea. Occurs when the throat muscles relax and airways become blocked.

Central sleep apnea. Occurs when the brain doesn’t send signals to the muscles involved in breathing.

Complex sleep apnea syndrome. Occurs when a person has both of the other types – obstructive sleep apnea and central sleep apnea.

For our purposes, we will talk mostly about obstructive sleep apnea since it is the most common of the three types.

We have muscles in the back of our throats that support the tongue, soft palate, uvula (the triangle-shaped piece of tissue that hangs down), tonsils, and the sides of our throat. When someone suffers from obstructive sleep apnea, these muscles relax over and over during sleep and fail to keep the airway open. Because the airway is blocked, breathing is repeatedly interrupted or paused for at least ten seconds as many as 30 times per hour throughout the night. Often these pauses are accompanied by a snorting or choking sound.

When you are unable to breathe in, your brain senses a troublesome situation and will briefly rouse you from your sleep in order to get your airway opened again. This awakening is usually so minor that you won’t remember it the next morning, but it takes a heavy toll. The disruptions not only lower the level of oxygen in your blood but can impact your most restful phases of sleep, causing you to feel extremely sleepy during the daytime.

Being overweight or obese. The risk of sleep apnea in people who are overweight is four times as great as in people who maintain a normal weight for their height since fat deposits around the upper airway (common in overweight people) can obstruct breathing.

Having a thick neck. Thicker necks may cause airways to be narrower. In men, a thick neck is defined as a circumference of 17” and up. In women, it is defined as a circumference of 15” and up.

Inheriting a narrow airway. Some of us have narrow airways simply because of our genes. We can also inherit a tendency for our tonsils to become enlarged and block the airway.

Being older. After the age of 40, sleep apnea occurs much more often.

A family history of the condition. We are at increased risk of having sleep apnea ourselves if we have family members with the disorder.

Using alcohol, sedatives, or tranquilizers. Because all of these things relax the muscles in our throats, they can contribute to the development of OSA.

Smoking. Smoking causes inflammation and fluid retention in the upper airway, which greatly restrict airflow. Smokers are, in fact, three times more likely to have obstructive sleep apnea than non-smokers.

Experiencing frequent nasal congestion. Whether due to allergies or structural problems like a deviated septum, the risk of developing OSA goes up if you have difficulty breathing through your nose.

Because you may not be aware of snoring or choking/gasping during the night, it might be helpful to take your partner or a family member with you to this appointment so they can share what they have observed with your doctor.

Physical exam

Your doctor will examine you physically to determine if you have tissue blockages in your throat, an enlarged soft palate or uvula, swollen tonsils, or obstructions in your nose, all of which can interfere with normal breathing at night and be causes of sleep apnea.

Sleep study (at a sleep center/lab or hospital)

A formal sleep study is a test that measures the quality of your sleep and how your body is acting during sleep by recording the following while you sleep:

Eye movement

Heart rate

Breathing effort

Airflow Blood oxygen levels

This data is then analyzed by a doctor who is a sleep specialist to determine whether you have sleep apnea or some other type of sleep disorder.

The test is performed at night in a private bedroom at a sleep lab or in a hospital where:

Technicians will apply electrodes or sensors to the skin on your face and scalp

These electrodes are connected to testing equipment that captures brain signals and muscle activity

Belts will be put around your chest and abdomen to monitor your breathing

A device will be put on your finger that measures the amount of oxygen in your blood

Sleep study (at home)

A version of the sleep study can be done at home with a portable device in cases that are considered to be less complicated. The equipment is provided to the patient who will apply the electrodes, sensors, and belts themselves for 1 to 3 nights then return the equipment to their doctor’s office for data analysis.

Sleep apnea symptoms

Symptoms of sleep apnea – whether the most common obstructive sleep apnea or the less common central sleep apnea – are shared by several other sleep disorders and physical conditions which may be one of the reasons so many cases are left undiagnosed. And many of the symptoms are ones that you may not know are occurring since they happen during sleep. Oftentimes, a family member or bed partner is needed to recognize them or properly describe them during a visit to your physician.

The two most common indicators that someone might have sleep apnea are extremely loud snoring (so loud bed partners may find it intolerable) and excessive daytime sleepiness. But other symptoms are more subtle and include:

Choking and gasping during sleep

Dry mouth or sore throat in the mornings

Morning headaches

Difficulty concentrating

Irritability or moodiness

Memory difficulties or forgetfulness

Falling asleep while working or driving

Depression

Obesity/being overweight

While not everyone who experiences these symptoms will have OSA, it is best to see a doctor for evaluation if you are experiencing them.

If you suspect that your children may suffer from sleep apnea, be aware that the symptoms of the condition are somewhat different in children and can include:

Snoring regularly with gasps for air between the snores

Heavy breathing while sleeping

Sleeping in abnormal positions

Sweating heavily during sleep

Bedwetting (especially if this is a new behavior)

Breathing regularly through the mouth

Behavioral problems

Daytime sleepiness

When children do not sleep well, they are more likely to be hyperactive and have problems paying attention the following day, which are also indicators of ADHD. As a result, getting a confirmed diagnosis for your child so that proper treatment can begin is critical.

Sleep apnea treatment

Sleep apnea is a chronic condition that requires long-term, consistent management. When sleep apnea is left undiagnosed and/or untreated, it can have devastating consequences, some of which are even life-shortening. The most serious are:

The treatments that are available for OSA vary and will depend on both severity and your personal medical history, but themost effective include lifestyle changes, mouthpieces, breathing devices, and/or surgery.

Lifestyle changes

While sleep apnea is a disorder that is best treated by medical specialists and a multi-faceted treatment plan, the most readily available solutions are simple lifestyle changes such as:

Sleep on your side. While sleeping on your back may be the most natural and comfortable position, it contributes to sleep apnea and snoring. Lie on your side and put a pillow behind your back or pin a tennis ball in a sock to your pajamas to prevent rolling over in your sleep.

Mouthpieces

Some people with mild to moderate cases of sleep apnea get relief from oral appliances or mouthpieces that are designed to help keep the airway open during sleep. These devices work by moving the lower jaw and tongue forward, preventing it from blocking the back of the throat.

While some over-the-counter mouthpieces are available online and in stores, it is best to have them specially constructed by a dentist who has experience treating sleep apnea and who will customize the mouthpiece for each patient. This ensures the device fits properly and is comfortable. Then you will need to follow up with your dentist on a regular basis to make sure the fit remains good.

Breathing devices

For the treatment of moderate to severe cases of sleep apnea, doctors will often prescribe a device that helps nighttime breathing called a PAP (positive airway pressure) device. There are four types of PAPs, all of which work by monitoring and controlling air pressure when you breathe in and out in order to keep your airway open.

BPAP – Bilevel Positive Airway Pressure. When the air pressure a person needs to keep the airway open when breathing out is higher than what they need when breathing in, a BPAP will be used. The BPAP mask and machine simply control pressure for breathing in both directions.

APAP – Auto-Adjusting Positive Airway Pressure. This mask and machine set positive airway pressures in both directions to the lowest levels required to keep the airway open. They are more comfortable to use than CPAP and BPAP but are more expensive, and may also be known as Automatic Positive Airway Pressure.

EPAP – Expiratory Positive Airway Pressure. Instead of a mask, these devices are small and only placed over the nostrils. The device valves allow you to breathe in normally, but when you breathe out, they close so air has to go through small holes in the valve. This increases airway pressure and keeps it open.

Your doctor will determine which one of these PAPs is best based on the severity of your symptoms and what is most comfortable for you. If a device is uncomfortable for you, it is important that you not stop using it. See your doctor to find out what modifications or adjustments he or she can make to get the device to work for you.

Surgery

Surgery is the most extreme treatment for sleep apnea and is an option only after more conservative treatments have failed for several months. There are several surgical procedures that can be used but all of them are designed to open up and enlarge the airway.

Nasal surgery. This surgery will straighten the cartilage between your nostrils or remove polyps that might be making it difficult to breathe.

Tonsil oradenoid removal. When tonsils or adenoids are enlarged, they can block the airway. Surgery to remove them can make breathing easier.

Weight-loss surgery. Because losing weight is the single most effective strategy for treating sleep apnea, some patients who are unable to lose weight through traditional methods may be candidates for one of severalsurgeries that diminish the size of the stomach.

Tissue removal. While this is not as reliable as the other surgery options, sometimes your doctor will remove tissue from the top of your throat and the back of your mouth to enlarge your airway. This tissue removal is sometimes done at the same time as tonsil and/or adenoid removal.

While some people will get the best results by using a combination of treatments, the good news is that obstructive sleep apnea is a disorder that is completely treatable and in many cases, curable.

Top tips for coping with sleep apnea

As we noted in our section on sleep apnea treatment, it is important to remember that there are many things you can do on your own to help you cope with the condition. The most important, by far, is weight loss since shedding excess weight can sometimes cure sleep apnea. Getting to and maintaining a healthy weight should be a priority for anyone who is overweight and has OSA.

In addition to weight loss, use these strategies to ensure you are doing everything possible to avoid the interruptions in breathing caused by this disorder and to keep yourself safe from harm if you are experiencing daytime sleepiness:

Keep your nasal passages open. To make sure your nasal passages are completely open, use a saline nasal spray at night. Before using other over-the-counter medicines such as decongestants or antihistamines, talk to your doctor since these medicines should not be used long-term.

Sleep on your side. While sleeping on your back may be the most natural and comfortable position, it contributes to sleep apnea and snoring. Learn more about finding the best mattress for side sleepers.

Do not drive if drowsy. You are at much higher risk of accidents if you drive while drowsy. If your sleep apnea is causing daytime sleepiness, avoid driving.

Involve your family members. Bed partners in particular can be helpful in identifying the first signs of sleep apnea and can assist in conveying important information to your doctor.

Sleep apnea FAQs

What is sleep apnea?

Sleep apnea is a sleep disorder in which breathing is interrupted constantly throughout the night when the airways become blocked (obstructive sleep apnea) or when the brain doesn’t send signals to the muscles involved in breathing (central sleep apnea).

What causes sleep apnea?

Obstructive sleep apnea occurs when the muscles in the back of the throat relax over and over during sleep and fail to keep the airway open.

Who can sleep apnea affect?

Sleep apnea can affect anyone, even children, but is most often seen among men age 40 and over and is particularly prevalent in African-American and Hispanic men.

What are the symptoms of sleep apnea?

The most common symptoms are:

Chronic snoring

Excessive daytime sleepiness

Difficulty concentrating

Irritability or moodiness

Depression

Obesity/being overweight

How is sleep apnea treated?

People suffering from sleep apnea can make lifestyle changes to improve symptoms but can also be treated with mouthpieces that help open airways, breathing devices that are worn at night, or surgery to open up airways.

Resources for sleep apnea

If you or someone in your family suffers from sleep apnea, the resources below will provide valuable information about the disorder itself and where to find help and support for coping with the impact of sleep apnea on quality of life, work, and family.

The American Sleep Apnea Association is an organization exclusively dedicated to supporting people with sleep apnea. It even offers a free app you can download that helps you monitor your symptoms and cope with the disorder.

DreamMapper is an outstanding smartphone app that allows you to record daily symptoms and includes a wealth of information on everything related to sleep apnea. The free app also provides daily motivational messages and tips for sleeping better at night.

Well-respected for their research on a wide variety of health issues, including disorders like sleep apnea, the Mayo Clinic and the Stanford Center for Sleep Sciences are both sources for in-depth information about the basics of sleep apnea as well as available treatments.

HelpGuide is an important online source of articles and information for thousands of people with sleep apnea.

Sharecare is an online resource where you can set up a personal health profile and, based on your age and activity level, get customized information from experts about how to improve your health when you have sleep apnea.

A leading publisher of health and fitness information that inspires or “sparks” people to live healthier lives is Spark People. Their website offers advice, tools, and a large online support community for staying healthy and socially engaged when you have sleep apnea.

The website Daily Strength has a robust sleep apnea support community consisting of thousands of sleep apnea patients who share information and encourage one another.